This section of somatology is associated with changes in the quality and volume of gums. A specific approach is needed here, since the soft tissues of the oral cavity and mucous membrane have their own characteristics. Soft tissue plastic is included in surgical dentistry. Today, there are about 100 methods of performing soft tissue plastic surgery. Let's talk about this in more detail.
The most common task of this branch of dentistry is to change the volume and characteristics of the gums after tooth loss. If more than a year has passed since the removal or loss, the jaw bone tissue atrophies and decreases in volume. Gums also change their characteristics. As a result, implant installation becomes impossible. The density and elasticity of atrophied soft tissues also does not allow the dental system to fully function. Soft tissue plastic
designed to solve this problem.
To restore the functionality of soft tissues, transplantation is performed. The dentist takes material from the patient from a healthy area of the oral cavity and places it in place of the problematic area. The soft tissues of the oral cavity have excellent regeneration rates, and therefore the rehabilitation period lasts no more than a week. At this time, it is important to follow the doctor’s recommendations to avoid further tissue damage. The probability of engraftment is close to 100%.
For gum recession
Plastic surgery of soft tissues
and in this case it becomes necessary. When the space between the neck of the tooth and the gum increases, correction is necessary. As a result, the patient suffers from increased sensitivity of the problematic tooth. Eating hot, cold, sweet and sour foods leads to pain.
This problem often leads to the formation of a periodontal pocket. It contains food particles and, more seriously, pathogens. As a result, inflammation may develop, which will eventually lead to tooth loss.
Another fairly common problem is an insufficient vestibule of the oral cavity, a short frenulum of the lower, upper lip or tongue. To correct these problems, vestibuloplasty is required. It is recommended to perform frenuloplasty at an early age. It is often done in the maternity hospital, while the frenulum is a small membrane without nerve endings. However, it is not contraindicated for adults either. It is performed under local anesthesia, stitches are placed on the wound, and the rehabilitation period lasts no more than two weeks. At this time, the dental system fully retains its functionality.
Guided tissue regeneration (GTR) –
This method can also be used to increase both the width of the alveolar process and its height. In addition, if the lack of bone tissue volume is not critical, then simultaneous installation of implants is possible along with bone grafting. However, the method also has its drawbacks, which we will discuss below.
Directed tissue regeneration (synonymous with directed bone regeneration) involves the use of two components: firstly, implanted bone material, and secondly, a special barrier membrane, the use of which will isolate the bone defect from the effects of adverse factors.
Guided bone regeneration: examples of operations
1) Clinical case No. 1 - in photo 17 (in the area of planned implantation) a significant bone defect is visible, which will be filled using a bioresorbable membrane and Bio-Oss bone material. In photos 21-22, taken 5 months after inert grafting, you can see the installation of the implant in this area...
2) Clinical case No. 2 – the use of guided bone regeneration techniques simultaneously with the installation of implants. The materials used were the inert material “Bio-Oss” and the resorbable membrane “Bio-Gaid”...
The significance of the barrier membrane - the barrier membrane performs the following functions: it allows you to give the desired shape and volume to the area of bone tissue being built up, protects the grafted bone from being absorbed by osteoclast cells (located in the periosteum), prevents the mechanical impact of the soft tissue of the gums on the grafted bone material and its deformation...
There are different types of membranes, resorbable (Bio-Gaid), non-resorbable (Gore-tex or titanium mesh membranes). The former dissolve on their own over time and do not need to be removed, but they hold their shape much worse compared to mesh titanium membranes or membranes with titanium reinforcement. All these membranes are expensive, but the use of cheap membranes (such as Osteoplast) is not suitable for this technique.
Selection of bone material - there are many different materials: based on synthetic hydroxyapatite, biopolymers, tricalcium phosphate, bioglass, based on bovine bone, etc. Below we will focus on the most effective types of bone materials (in descending order of their effectiveness).
- Use of a bone autograft – an autograft should be understood as bone material that is taken from the patient himself in other parts of the jaws (for example, in the form of bone chips or a bone block). There is only one downside - the need for an additional small intervention to collect bone material.
- A combination of autograft + xenograft - in a 1:1 ratio, bone chips (taken from the patient) are mixed with material of xenogeneic origin, i.e. based on bovine bone. An example of this is such high-quality and effective material as “Bio-Oss”. This is a very effective combination for increasing bone volume.
- The use of allograft - this type of bone material is also very effective, but is used much less frequently. The fact is that the source of bone material in this case is cadaveric material (of other people). These materials are purchased from a special tissue bank; all materials undergo careful processing and are completely safe, but for psychological reasons they are used less frequently.
- The use of pure xenograft - the Bio-Oss material (based on bovine bone) can be used without mixing it with the patient’s own bone chips, but then the efficiency of bone augmentation will be lower.
Guided bone regeneration with simultaneous implantation: video of the operation
- Video 1 – using Bio-gaid resorbable membrane,
- video 2 - using a mesh titanium membrane.
Important: it should be noted that this method is not always effective enough. The fact is that the bone material is “planted” outside the cortical plate of the jaw (a very dense surface layer of bone). The newly formed bone differs in structure from the native jaw bone, does not have its own cortical plate on the outside and therefore has a tendency to subsequent partial resorption.
Therefore, it is necessary to carry out bone augmentation using this method “with a reserve” for the planned degree of future resorption, which will be more pronounced the thinner the gum biotype (gingival thickness). This is due to the fact that the surface layers of the bone will receive less oxygen and nutrients due to their less blood supply.
Plastic methods
Soft tissue grafting uses several methods. Here are the most common methods of intervention.
- Tunnel. In this case, trauma to the oral cavity is minimized. The surgeon makes small incisions in the mucosa to access the tissue. The wound heals quickly, since the soft tissues of the oral cavity have an increased regeneration rate. The rehabilitation period is minimal.
- Soft tissue grafting uses an autograft. Healthy tissue is collected from the patient himself. This is the most reliable method, since the probability of engraftment tends to 100%.
- For deep correction of the soft tissues of the oral cavity, the method of free plastic surgery with a displaced flap is used.
The dentist chooses the methods of influence based on the characteristics of the situation. All procedures do not require general anesthesia. If you think you need soft tissue plastic surgery, contact our dental clinic in Tula.
Causes of bone deficiency:
1) The main reason for the decrease in bone tissue volume is the natural atrophy (resorption) of bone, which occurs in the area of extracted teeth. This happens because the bone loses support in view of the tooth root, and also because in the absence of the tooth root, chewing pressure ceases to be exerted on the bone tissue. As a consequence, there is a decrease in bone volume, which can occur both in height and in width of the alveolar process of the jaw.
2) The second reason is the traumatic removal of decayed teeth by dental surgeons. Usually, during removal, the surgeon does not think at all about the safety of the bone walls of the alveoli around the tooth, biting them off with forceps. If you are planning extraction followed by tooth implantation, then it is best to carry out such removal by an implant surgeon, who will try to preserve the bone tissue as much as possible.
There are 3 types of bone resorption –
- horizontal resorption (Fig. 2), when the width of the alveolar process decreases,
- vertical resorption (Fig. 3), i.e. when there is a decrease in the height of the alveolar process,
- + combined form.
According to the type of resorption in a particular patient, a bone grafting technique is selected, aimed at increasing the width and/or height of the alveolar process of the jaw.
Why is photometry needed and what is condylography?
Photometry is the taking of photo parameters, simply - photographing with an open and closed mouth, with and without a smile, frontal and profile. Photographs are needed not only to evaluate the result before and after, but also to develop an individual denture.
When developing a prosthetic model, we use the principles of the “golden ratio” - the rules for dividing the face into segments. Thanks to prosthetics and implantation, you can restore your bite, get rid of wrinkles, and change the lower third of your face. That is, to make you more attractive.
Condylography is the measurement of parameters of occlusion (closing of the jaws) and the functioning of the temporomandibular joint; in fact, it is a functional diagnosis. Our clinic uses a HIP plane analyzer, a facebow and an articulator. Together, they allow you to assess how the entire jaw system will work after the installation of a denture, how you need to correct your bite and straighten the position of the two jaws relative to each other in order to relieve the load on the temporomandibular joint and allow you to chew without discomfort.
Of course, such a procedure is primarily necessary when a large number of teeth are complete or missing. With single restorations or if there are no malocclusions, such a diagnosis makes no sense.
Such parameters are taken twice – at the stage of preparation for dental implantation, and also after taking impressions before installing the prosthesis. In case of complete absence of teeth, as well as after their partial removal and fixation of implants, the bite changes slightly - this must be taken into account so that the prosthesis is comfortable throughout its entire service life.
The task of our doctors is to make not only beautiful dentures, but also to restore the function of the teeth. So that you can chew any food without pain and with pleasure.
Bone tissue augmentation during dental implantation: price 2021
How much does jawbone augmentation for a dental implant cost in 2021?
Augmentation of bone tissue for implantation - the cost will differ from the type of technique and the volume of the operation (in the area of how many teeth it is performed), as well as from the type and volume of bone material and membrane used. Bone tissue augmentation during dental implantation: price 2021
- Splitting of the alveolar process - in the area of 1-2 teeth will cost about 15,000 rubles + the cost of materials, which in this case can be used inexpensively and the materials will cost 3-5 thousand rubles.
- The operation to collect and transplant a bone block will cost about 36,000 rubles (this cost includes both the collection and transplantation of a bone block, but does not include the cost of additional materials, for example, a membrane, which will cost another 13,000 rubles).
- The technique of directed tissue regeneration - the NTR technique in the area of 1-3 teeth will cost approximately 25,000 rubles (excluding the cost of the membrane and bone material).
If we take high-quality European materials, then the cost of the Bio-Guide membrane is about 13,000 rubles, and the cost of the Bio-Oss bone material (0.5 g packaging) is about 12,000 rubles. If this technique is carried out simultaneously with the installation of an implant, then the price of the service (excluding the cost of bone material and membrane) will be from 5,000 to 10,000 rubles - in addition to the cost of installing the implant. Additionally, the patient will incur costs for bone material and membrane (prices are indicated above).
- Sinus lift surgery is performed in the lateral parts of the upper jaw and consists of raising the bottom of the maxillary sinus. The cost of a closed sinus lift starts from 10,000 rubles, an open one – from 25,000 rubles, but keep in mind that this cost does not include additional materials (membrane, grafted bone material).
Step 6: Abutment Installation
The abutment is screwed directly into the implant root; it is the abutment that is the connecting link between the implant and the crown/prosthesis. The abutment is installed 2 weeks after the former and is selected individually for each client.
For example, when implanting teeth in the smile area and thin gum tissue, it is recommended to install zirconium abutments, since titanium “spare parts” can negatively affect aesthetics.
Placement of the abutment completes the implantation procedure and treatment continues with the prosthodontist.
